Once in a great long while you read something in the New York Times or the New Yorker or the Atlantic which is really different, new and gives you pause.
"Surgery, Hormones, But Not Happiness," in the 11/25/18 NYT is one of those.
Speaking about her "transition" from male to female, Ms. Chu hits the main themes, that nobody ought to be made to feel badly, demeaned over something they cannot control, over a strong urge to change from what they have been to something different.
But she also touches on the very important reservations at least some doctors have about participating in the treatment of patients who say they feel they have been born in the wrong body, the wrong sex.
She addresses head on the medical aphorism: "First, do no harm," by asking what makes the doctor think he can always know whether or not he has done harm?
It is a fair question.
But Paul McHugh, when he left Cornell and went to Johns Hopkins, where he was asked to participate in the Hopkins transgender program as chief of psychiatry, some 40 years ago, discovered the suicide rate among patients undergoing transgender surgery and hormone medication was somewhere above 30%. He asked, "What other practice in medicine would be continued with a 30% death rate? Would coronary bypass surgery be allowed if 1/3 of the patients died?"
Nothing has changed in the suicide rates of transgenders since then, far as I can discern--in fact it is usually quoted as being close to 40%.
Discussing the reluctance of physicians to treat patients with "gender dysphoria" Ms. Chu remarks:
"In this view, it is not only fair to refuse trans people the care they seek,; It is also kind. A therapist with a suicidal client does not draw the bath and supply the razor. Take it from my father, a pediatrician, who once remarked to me that he would no sooner prescribe puberty blockers to a gender dysphoric child than he would give a distemper shot to a someone who believed she was a dog."
But what Ms. Chu argues is it is not for the doctor to make the judgment. The goal ought not to be to make a patient happy. Even after receiving treatment, she says, few transgender patients are happy. The goal is to serve the stated needs of the patient.
"As long as transgender medicine retains the alleviation of pain as its benchmark of success, it will reserve for itself with a dictator's benevolence, the right to withhold care from those who want it."
She then decries the condescension.
"I also believe that surgery's only prerequisite should be a simple demonstration of want. Beyond this, no amount of pain, anticipate or continuing, justifies it's withholding."
Up to this point, I was in Ms. Chu's thrall, but she lost me here.
The surgeon, it should be noted, also has a right to decide how much pain he is willing to inflict.
If you have a transgender surgeon who wants to do the surgery, fine.
But for my part, I do not see participating in what is a very unsettled realm which may be doing more harm than good, whoever gets to define that.
"Surgery, Hormones, But Not Happiness," in the 11/25/18 NYT is one of those.
Speaking about her "transition" from male to female, Ms. Chu hits the main themes, that nobody ought to be made to feel badly, demeaned over something they cannot control, over a strong urge to change from what they have been to something different.
But she also touches on the very important reservations at least some doctors have about participating in the treatment of patients who say they feel they have been born in the wrong body, the wrong sex.
She addresses head on the medical aphorism: "First, do no harm," by asking what makes the doctor think he can always know whether or not he has done harm?
It is a fair question.
But Paul McHugh, when he left Cornell and went to Johns Hopkins, where he was asked to participate in the Hopkins transgender program as chief of psychiatry, some 40 years ago, discovered the suicide rate among patients undergoing transgender surgery and hormone medication was somewhere above 30%. He asked, "What other practice in medicine would be continued with a 30% death rate? Would coronary bypass surgery be allowed if 1/3 of the patients died?"
Nothing has changed in the suicide rates of transgenders since then, far as I can discern--in fact it is usually quoted as being close to 40%.
Discussing the reluctance of physicians to treat patients with "gender dysphoria" Ms. Chu remarks:
"In this view, it is not only fair to refuse trans people the care they seek,; It is also kind. A therapist with a suicidal client does not draw the bath and supply the razor. Take it from my father, a pediatrician, who once remarked to me that he would no sooner prescribe puberty blockers to a gender dysphoric child than he would give a distemper shot to a someone who believed she was a dog."
But what Ms. Chu argues is it is not for the doctor to make the judgment. The goal ought not to be to make a patient happy. Even after receiving treatment, she says, few transgender patients are happy. The goal is to serve the stated needs of the patient.
"As long as transgender medicine retains the alleviation of pain as its benchmark of success, it will reserve for itself with a dictator's benevolence, the right to withhold care from those who want it."
She then decries the condescension.
"I also believe that surgery's only prerequisite should be a simple demonstration of want. Beyond this, no amount of pain, anticipate or continuing, justifies it's withholding."
Up to this point, I was in Ms. Chu's thrall, but she lost me here.
The surgeon, it should be noted, also has a right to decide how much pain he is willing to inflict.
If you have a transgender surgeon who wants to do the surgery, fine.
But for my part, I do not see participating in what is a very unsettled realm which may be doing more harm than good, whoever gets to define that.
Phantom,
ReplyDeleteTruly a quagmire. A description Ms.Chu would most likely take exception to, since for her the issue appears to be black and white-the only prerequisite for surgery is want. This, however certainly lowers the bar below the threshold employed in determining whether other types of surgeries and procedures are performed. For example, one can't merely want surgery on a bum knee-the pros and cons would be weighed out to determine if surgery is the best alternative. There are other factors to consider besides wanting it, although, I do see Ms. Chu's point that making the patient a "happier person " isn't typically one of them.
I'm not in agreement with her position that "First do no harm" doesn't apply or that the ability to decide that a conceit on the part of the surgeon. By her own admission, Ms Chu is currently severely depressed, borderline suicidal and planning an imminent, elective surgery with a long, painful recovery and potentially lifelong physical complications. If the suicide rate for those having the surgery is anywhere near as high as 40%, how could it be in her best interest right now to proceed. Like I said, a quagmire.
Maud
Ms. Maud,
ReplyDeleteLike the #METOO movement, the idea that transgender medicine can be reduced to a simple formula leads to absurdity.
Nature provides clear examples of gender confusion in homo sapiens: a disorder called "17 hydroxylase deficiency" can result in children who are born with female external genitalia but never "feel" female and ultimately choose a male identity. The more famous 5 alpha reductase deficiency (described in "Middlesex") results in girls who "transform" into boys at puberty, growing a penis from what was thought to be a clitoris--or at least that was what the original reports claimed.
The real problem is when these medical/biological problems become the Provence of Rush Limbaugh, Pat Robertson and Fox and Friends, not to mention Sherry Frost and the harridans of the left.
Phantom